Standards for Reporting of the Thoracic Aorta on Computed Tomography and Magnetic Resonance ImagingViewing and measuring are best accomplished at a picture archiving and communications system workstation or an independent computer workstation, in which the aorta can be rotated into the best orientation to review each segment of the e282 Circulation

ince the initial publication of ''Guidelines for Reporting Morbidity and Mortality After Cardiac Valvular Operations'' in 1988, 1 followed by a revised version in 1996, 2 valvular heart surgery has evolved to include an enhanced understanding of patient-and disease-related factors affecting outcomes, increased numbers of valve repairs, more operations performed for patients with minimal symptoms, new prostheses, novel repair methods, and the emergence of percutaneous interventional (catheter-based) valve repair and replacement. To adapt to this changing environment, the Councils of the American Association for Thoracic Surgery, The Society of Thoracic Surgeons, and The European Association for Cardio-Thoracic Surgery have directed an Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity to review current clinical practice to update and clarify these reporting guidelines. The guidelines are intended to cover treatment of all four cardiac valves in both adult and pediatric patients. Further, these guidelines apply uniformly, irrespective of whether the therapy was carried out as a conventional open operation, as a minimally invasive (video-assisted or robotic) surgical procedure, or with percutaneous interventional catheter techniques. PurposeThese reporting guidelines are intended to facilitate analysis and reporting of clinical results of various therapeutic approaches to diseased heart valves such that meaningful comparisons can be made and inferences drawn from investigations of medical, surgical, and percutaneous interventional treatment of patients with valvular heart disease. Early MortalityEarly mortality is to be reported as all-cause mortality at 30, 60, or 90 days and depicted by actuarial estimates (with number remaining at risk and confidence intervals [CIs]) or as simple percentages, regardless of the patient's location, be it home or in a health care facility.

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Elective aortic-root replacement has a low operative mortality. In contrast, emergency repair, usually for acute aortic dissection, is associated with a much higher early mortality. Because nearly half the adult patients with aortic dissection had an aortic-root diameter of 6.5 cm or less at the time of operation, it may be prudent to undertake prophylactic repair of aortic aneurysms in patients with Marfan's syndrome when the diameter of the aorta is well below that size.

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During a 16-year interval ending in October 1990, 168 patients underwent 172 aortic root replacements. Thirty patients (18%) had Marfan syndrome. Annuloaortic ectasia (81 patients) and aortic dissection (63 patients) were the principal indications for operation. Twenty-seven patients (16%) had previous operations on the ascending aorta or aortic valve. The hospital mortality rate was 5% and the duration of cardiopulmonary bypass was the only significant independent predictor of early death (p = 0.017). Major modifications in technique were made in 1981, when the inclusion/wrap technique employing a composite graft (used in the first 105 procedures) was abandoned in favor of an open technique (used in 51 procedures), and in 1988, when aortic allografts and pulmonary autografts were introduced for selected conditions (reoperations, dissection, endocarditis, isolated aortic valve disease) in 16 patients. The mean duration of follow-up was 81 months. Forty-six patients were followed for more than 10 years. The actuarial survival rate was 61% at 7 years and 48% at 12 years. No significant difference in survival rate was observed between the patients with annuloaortic ectasia and aortic dissection, or between the inclusion/wrap and open techniques. However the frequency of pseudoaneurysm formation at suture lines and the frequency of reoperations on the ascending aorta and aortic valve were less with the open technique. The actuarial freedom from thromboembolism for the 152 patients with prosthetic valves was 82% at 12 years. One early and one late death occurred among the 16 patients with allograft or autograft root replacement. Anticoagulant therapy was not used in these patients and no thromboembolic episodes occurred in the follow-up period (mean, 7 months). The satisfactory results observed with extended follow-up support the continued use of the composite graft technique as the preferred method of treatment for patients with annuloaortic ectasia, persistent aneurysms of the sinuses of Valsalva following previous operations, and for patients with ascending aortic dissection who require aortic valve replacement. The availability of aortic root allografts and the perfection of techniques for safe implantation of the autologous pulmonary root into the aortic position have broadened the indications for aortic root replacement.

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Surgical ventricular restoration improves ventricular function and is highly effective therapy in the treatment of ischemic cardiomyopathy with excellent five-year outcome.